(1) To determine the prevalence of swallowing problems in MS patients
and its relation to the overall disability.
(2) To define the most frequent symptoms suggestive of dysphagia.
(3) To describe the abnormalities on manofluoroscopy (MFS).

METHODS:

Three hundred and eight consecutive MS patients were asked whether they
ever had swallowing problems. If so the questionnaire of the Johns Hopkins
Swallowing Centre was applied to qualify the dysphagia. A MFS was performed
in 30 patients with dysphagia covering the entire spectrum of MS. Overall
disability was assessed using the Expanded Disability Status Scale (EDSS).

RESULTS:

Seventy-three of our 309 patients had permanent dysphagia (24%). Another
5% had a history of transitory swallowing problems only. Permanent dysphagia
started to be a problem in mildly impaired patients (EDSS 2-3). Prevalence
increased together with rising disability to reach 65% in the most severely
disabled subjects (EDSS 8-9). Two alarming symptoms of patients with swallowing
problems, coughing or choking during the meal and a history of pneumonia
were present in 59%, respectively, 12% of these patients. MFS showed deficiency
of the oral phase in all patients, while only the patients with an EDSS
higher than 7.5 showed abnormalities of the pharyngeal phase.

CONCLUSIONS:

Permanent dysphagia may already develop in mildly impaired MS patients
but becomes a rather frequent finding in MS patients with moderate or severe
disability. MFS is a sensitive and useful ancillary examination. Important
qualitative changes of the pharyngeal phase on MFS are seen in patients
with an EDSS higher than 7.5.